title: Prognostic value of EEG asymmetries for development of drug-resistance in drug-naïve patients with genetic generalized epilepsies.
abstract: OBJECTIVE
  Previous studies based solely on visual EEG analysis reported equivocal results regarding an association of pharmaco-resistance with EEG asymmetries in genetic generalized epilepsies (GGE). We addressed this issue by applying both visual and quantitative methods to the pretreatment EEG of GGE patients.
  
  
  METHODS
  Socio-demographic/disease characteristics and response to treatment/discontinuation trial for these patients were recorded at 6months and at last follow up. The first EEG was retrospectively, blindly, and visually assessed for focal slowing, focal discharges and also quantitatively analyzed for amplitude or latency asymmetries of generalized discharges. Association between these variables and development of drug-resistance was evaluated.
  
  
  RESULTS
  Out of 51 subjects, 40% had some type of EEG asymmetry by visual, 37% by quantitative and 54% by combined analysis. Drug-resistance was identified in 52% of patients after 6months and in 24% at the end of the follow up period (∼4.2years). 27% of patients underwent a discontinuation trial; 43% unsuccessfully. There was no association between baseline EEG asymmetries of any type and refractoriness to medical therapy, regardless of analytical method used.
  
  
  CONCLUSIONS
  In a carefully selected cohort of medication-naïve GGE patients, visual and quantitative asymmetries in the first EEG were not associated with the development of pharmaco-resistance.
  
  
  CONCLUSIONS
  These findings do not provide support for utilization of EEG asymmetries as a prognostic tool in GGE.
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: ioannis.karakis@emory.edu.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Karakis
authors.affiliation: MGH Epilepsy Service, Harvard Medical School, Boston, MA, USA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Pathmanathan
authors.affiliation: MGH Epilepsy Service, Harvard Medical School, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Chang
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
authors.affiliation: MGH Epilepsy Service, Harvard Medical School, Boston, MA, USA.
authors.forename: Sydney S
authors.initials: SS
authors.lastname: Cash
authors.affiliation: MGH Epilepsy Service, Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D004351:Drug Resistance / Q000502:physiology*; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000927:Anticonvulsants
keywords: Drug resistance; EEG; GGE; IGE; Spike-wave asymmetries